“Your brain is your greatest weapon. Connect it to your heart, and you can go anywhere.” Angelique Kidjo
“Don’t believe everything you hear – even in your own mind.” Daniel Amen
Précis: A big fear for anyone with Parkinson’s is the development of dementia. It is predicted that a large percentage of those with Parkinson’s will eventually develop dementia. This blog post is just a brief introduction to the topic of dementia in Parkinson’s because, like you, I want to know more.
“The mind, once stretched by a new idea, never returns to its original dimensions.” Ralph Waldo Emerson
Dementia Defined: According to the CDC, dementia is not a specific disease but a general term for the impaired ability to remember, think, or make decisions that interfere with everyday activities. Think of dementia in Parkinson’s, when areas of thinking become dysfunctional enough to alter your day-to-day activities or functioning. You are probably thinking, is dementia in Parkinson’s the same as in Alzheimer’s? Hopefully, the explanation below will reassure you to some extent that Parkinson’s dementia is very different from Alzheimer’s dementia.
“Human beings can alter their lives by altering their attitudes of mind.” William James
The Complex Circuitry of Dopamine and the Brain: We historically refer to Parkinson’s as a movement disorder, and it is. Unfortunately, the non-motor-related changes are equally challenging and potentially more problematic.
The loss of dopamine synthesis from the substantia nigra pars compacta causes a cascade of issues with many essential brain regions. Alpha-synuclein aggregation in neurons leads to Lewy body deposits, further activating the immune and inflammatory systems. In others, genetic alterations/changes promote this detrimental symphony in neurons.
The result is less dopamine going to the basal ganglia, which is involved in motor functions and thinking. From here, reduced amounts of dopamine move to the frontal lobes and nucleus accumbens. These brain regions are vital for our behavior, emotion, personality, mood, and thinking. We must never forget that Parkinson’s is a combined disorder of motor- and non-motor problems.
“In years that bring the philosophic mind.” William Wordsworth
Examples of Dementia in Parkinson’s: Below is some brief descriptions of dementia found in Parkinson’s. It is not a complete or thorough presentation, just an introduction. These changes may occur throughout the disorder’s progress, they may be directly related to disease progression or due to alterations in therapy, and some may be prompted by treatment.
Your care partner must be aware of these possibilities because you may have some of these symptoms and may not be aware of them. Your healthcare team can deal with these changes in many instances, so it is essential to be ready to discuss the mental side of your disorder. This post will not answer many questions about these issues but to get the ball rolling by presenting them. At the bottom of the post are some reference materials on dementia in Parkinson’s.
Memory– In Parkinson’s, you may have a more challenging time retrieving information, but it is still there. Importantly, you will not forget who you are or be unable to identify family members and friends. That memory is intact, but accessing it may be more of a challenge.
Motivation– You may have always been motivated to work hard, exercise frequently, or do many other activities. However, sometimes in Parkinson’s, your brain changes, and that motivation and initiation are not always present. So one’s “get up and go has got up and gone.” A topic that Enerst Tubbs sang about in 1965:
Changes in Your Speech and Looking for That ‘Word‘- At times, finding the word to use in a conversation may be harder. The word is ‘right there,’ but it will not come out. And your pattern of speech has changed, it is softer and less coherent than before.
Depression– You have an overwhelming feeling of sadness or hopelessness. You no longer enjoy the things you lived for, you are not interested in outside events around you.
Spatial Awareness– One may develop problems related to depth perception. You are unable to pinpoint something you see. You are possibly walking into walls, which may progress to something like visual hallucinations (when you see something that is not really there).
Dilusions in Psychosis– This relates to believing something that is not true. Some examples are this could be related to jealousy, body/health obsession, or you feel persecucted.
Clear one Moment, Confused the Next– Maybe it is hard to keep focused. Your thoughts go back and forth from clear to confused. And keeping your mind focused on a specific topic becomes problematic.
Executive Dysfunction– Executive function/dysfunction is where you have a harder time organizing your day and a more challenging time making decisions. It is problem-solving, planning, and difficulty in retrieving words.
“The mind is not a vessel to be filled but a fire to be kindled.” Plutarch
Trouble in Mind With Parkinson’s: Not to sugarcoat it, but our brains change due to this disorder. We are not crazy; we have Parkinson’s. A troubled mind would impact our day-to-day lives. Like everything else with Parkinson’s, it is hard to predict the percentage, penetrance, and effect dementia will have on each individual.
Your healthcare provider can help if they are informed about them. For instance, when you have lost motivation, your healthcare provider can determine if this is depression or apathy. Speech pathologists can help with your voice strengthening and finding your words. Treatment schemes for depression and hallucinations/paranoid feelings are available. Exercise can help manage some of these symptoms. In addition, your care partner will want to know what’s happening with your personality or decision-making abilities. They will think your actions are deliberate; in reality, they are caused by Parkinson’s.
Many of these events will be like a cloudy day turning to sunshine again a few hours later in that they may fluctuate throughout the day. But we know the cognitive and personality changes, along with the memory alterations in Parkinson’s, are not like those in Alzheimer’s. So keep active, learning, thinking, and engaging your mind, and let’s hope the changes you experience are minimal.
“You either control your mind or it controls you.” Napoleon Hill
Defining a Blues Song: According to Wikipedia, blues is a musical form that originated in the Deep South of the United States around the 1860s. Blues incorporated spirituals, work songs, field hollers, shouts, chants, and rhymed simple narrative ballads from the African-American culture. A moving tempo and a robust rhythm typically characterize a blues song.
I have always loved the blues because no matter how difficult the message in the song, there is always something in the music where one always feels alive after listening to a blues song. I have used this particular song before as an example of why the blues can move one, but watch this video of B.B. King singing “Why I Sing the Blues” because it will make you smile.
“Don’t allow your mind to tell your heart what to do. The mind gives up easily” Paulo Coelho
The Blues Song “Trouble in Mind:” This song is standard blues that has been around for many years. The composer of Trouble in MInd is Richard M. Jones, and it was written in the early 1900s. Numerous people have sung it over the years, including Dinah Washington, Sam Cook, Johhny Cash, LIghtenin’ Hopkins, and Nina Simone. Some of the most memorable lines in any blues song are in Trouble in Mind, which are:
“Trouble in mind, I’m blue / But I won’t be blue always / ‘Cause I know the sun’s gonna shine in my back door someday.”
The lyrics may vary slightly from song to song; however, every version includes this going-to-feel-good-one-day phrase.
Lyrics to Trouble in Mind (Live at Newport Jazz Festival) [2004 Remaster] Song by Nina Simone
Trouble in mind, i’m blue
But i won’t be blue always,
’cause the sun’s gonna shine
In my backdoor some day.
I’m all alone at midnight
And my lamp is burnin’ low
Ain’t never had so much
Trouble in my life before.
Trouble in mind, that’s true
I have almost lost my mind,
Life ain’t worth livin,
Sometimes i feel like dyin’.
Goin’ down to the river
Gonna take my ol’ rockin’ chair
And if the blues don’t leave me
I’ll rock away from there.
“Anyone who stops learning is old, whether at twenty or eighty. Anyone who keeps learning stays young. The greatest thing in life is to keep your mind young.” Henry Ford
Here is a version of Trouble in Mind by Nina Simone:
Here is a performance of Trouble in Mind by Lightnin’ Hopkins:
“The mind of man is capable of anything.” Joseph Conrad
Referenes to Dementia in Parkinson’s:
Pagonabarraga, Javier, and Jaime Kulisevsky. “Cognitive impairment and dementia in Parkinson’s disease.” Neurobiology of disease 46, no. 3 (2012): 590-596.
Aarsland, Dag, Julia Zaccai, and Carol Brayne. “A systematic review of prevalence studies of dementia in Parkinson’s disease.” Movement disorders: official journal of the Movement Disorder Society 20, no. 10 (2005): 1255-1263.
Brown, R. G., and C. D. Marsden. “How common is dementia in Parkinson’s disease?.” The Lancet 324, no. 8414 (1984): 1262-1265.
Walker, Lauren, Leonidas Stefanis, and Johannes Attems. “Clinical and neuropathological differences between Parkinson’s disease, Parkinson’s disease dementia and dementia with Lewy bodies–current issues and future directions.” Journal of Neurochemistry 150, no. 5 (2019): 467-474.
Kouli, Antonina, Marta Camacho, Kieren Allinson, and Caroline H. Williams-Gray. “Neuroinflammation and protein pathology in Parkinson’s disease dementia.” Acta neuropathologica communications 8, no. 1 (2020): 1-19.
Fereshtehnejad, Seyed-Mohammad, Chun Yao, Amelie Pelletier, Jacques Y. Montplaisir, Jean-François Gagnon, and Ronald B. Postuma. “Evolution of prodromal Parkinson’s disease and dementia with Lewy bodies: a prospective study.” Brain 142, no. 7 (2019): 2051-2067.